Through every stage of life, calcium is an important component of a woman’s diet. Calcium is involved in many aspects of overall health. It is believed to be important for bone health, prevention of cardiovascular disease, blood pressure regulation, weight management, and prevention of some types of cancer.

How Much Calcium Do You Need?

The recommended daily allowance of calcium for women between 19 and 50 years of age is 1,000 mg. That recommendation does not change when you are pregnant, but meeting it does become even more important, because you are providing nutrition for your baby as well, and his or her bones and teeth need calcium for proper development. In addition, when you don’t get enough calcium for a long period of time, you are at risk for developing osteopenia, which can lead to osteoporosis. What’s the difference? Osteoporosis is a disease that breaks down the tissue in our bones, making them fragile and more likely to break. Osteopenia is not a disease, but a term that describes low bone density. Both can lead to painful fractures. While osteopenia is not considered a disease, being diagnosed with osteopenia requires further monitoring. Preventive measures should be taken since osteoporosis may develop if bone density loss increases.

Actually, the real protection against osteoporosis begins when one is a teenager, because porousness of the bones is the end stage of a long process. Continuing to drink milk after childhood through the teenage years is like putting calcium in the bank to be drawn on later. Unfortunately, teenagers favor sodas over milk and not many drink the two glasses of milk a day that would allow them to meet more than half their daily calcium needs.

Which food has more calcium? A cup of collard greens or a cup of whole milk? The answer is collard greens! Eight ounces of skim milk contains almost 300 mg – even more than whole milk, and in a healthier, fat-free package. Yogurt and cheese are good sources of calcium too, but remember that dairy products are just one of many ways to get the calcium you need. Salmon, kale, broccoli, and calcium-fortified orange juice are just a few of the other many places to find calcium. I don’t believe that my orange juice should be calcium-fortified, but the manufacturers are offering the option. Just drink milk!

What about calcium supplements? Their safety is often called into question, although for now they appear to be harmless. The real issue is that supplements are not a stand-in for natural foods that contain calcium, because they lack the protein, vitamins, and minerals that you, and your growing baby if you are pregnant, both need. With just a little effort you can get all the calcium you need easily through a healthy diet.

Calcium need during menopause is 1200 milligrams per day. After menopause, it increases to 1500 milligrams per day. We once thought that calcium and Vitamin D supplementation should be taken to prevent bone fractures in postmenopausal women. However, the United States Preventive Services Task Force, an independent panel of experts in prevention and primary care, recently issued a draft statement in June, 2012, recommending that healthy postmenopausal women should NOT take low doses of calcium or Vitamin D supplements to prevent fractures. Why? Because the supplements were found NOT to prevent fractures and only increased the risk of other problems, such as kidney stones. So the risks outweighed the benefits and taking these supplements may actually be harming you.

Lactose Intolerance

Lactose intolerance is a common condition in which unpleasant symptoms such as bloating or diarrhea occur after consuming lactose, milk’s natural sugar. This happens when an individual does not produce enough of the enzyme lactase to properly break down the lactose. Lactose intolerance can unsurprisingly make it more of a challenge to consume enough calcium. However, some individuals can consume a small amount of milk without issue. Yogurt is often a good alternative. However, there are many products today designed for lactose-intolerant individuals. In addition, there are many non-dairy sources of calcium available such as kale, broccoli, collards, and foods fortified with calcium.

Can You Get Too Much Calcium?

Like anything other good thing, too much calcium can present potential problems. Hypercalcemia can cause renal and vascular problems, as well as kidney stones. It can also cause constipation. However, it’s important to realize that you would have to consume more than three times the recommended daily allowance of calcium for problems to begin to occur. Given the average American diet, this is just not a real concern. So drink plenty of skim milk and enjoy lots of other calcium-rich foods as part of your balanced nutritious diet, especially while you are pregnant, lactating or postmenopausal.

For more information about the risk factors associated with postmenopausal osteoporosis, I refer you to my health book, Inside Information for Women.

There is an ongoing struggle between patients, physicians, and managed care plans involving whether gynecologists should be able – or be expected – to serve as primary care physicians to women. Even among each group, there is disagreement on the best course of action. Patients may like the convenience of having only one main doctor. Gynecologists, while acknowledging that they do have adequate training to function as primary doctors, have conflicting preferences, with some believing that they should be primary doctors and others preferring to remain consultative specialists. Managed care plans allow women varying levels of access to gynecologists.

So how can a women decide what is right for her? Many women visit their gynecologists faithfully but never think about an annual physical. Others request physicals from their gynecologists. Still others visit both doctors regularly. The right choice depends on your preferences, the viewpoint of your gynecologist, and the guidelines set by your insurance company. One thing is certain: you need both exams yearly – a gynecological exam and a general physical exam – to promote good overall health and catch any potential problems early.

Why You Need a Yearly Physical Exam

During a physical, your doctor will not only perform a complete physical exam, but also discuss lifestyle habits, order appropriate screening tests, and administer age-appropriate immunizations. Lifestyle issues such as weight and tobacco use are discussed and plans formed for making positive changes.

Depending on your doctor’s style, your physical may include assessment of your vital signs, your family medical history, a heart and lung exam, a dermatological exam, an exam of your head, neck, extremities, and breasts. Blood tests may be ordered to screen for anemia, kidney disease, diabetes, high cholesterol, and other conditions. Depending on your age and history, other screening tests like colonoscopies and mammograms may be ordered.

An internist is experienced in managing high blood pressure, diabetes, high cholesterol, asthma, and other chronic conditions; they may also refer you to a specialist or coordinate your care with specialists you may already be seeing.

Why You Need a Yearly Gynecologic Exam

Regular physical exams are important, but it is equally important to take advantage of the specialized knowledge of gynecologists. When you visit a gynecologist for a well-woman exam, he or she can address issues such as fertility, birth control, sexually transmitted infections (STIs), cancer prevention, and other issues.

Gynecologists are also highly trained in performing pelvic exams and Pap smears, as well as counseling women on various health issues and lifestyle habits. Gynecologists also function as your consultants for major health issues regularly faced by women, now and through every stage of your life. At every age, there is a reason for a woman to see a gynecologist. She may need to discuss contraception, fertility, or genetic testing; she may need a clinical breast exam, a pelvic exam, or STI screening.

You decision about whether to see a gynecologist alone or a gynecologist and an internist depends on your preference, your medical history, your existing conditions, and the willingness of your gynecologist to serve in this role. If you decide to make your gynecologist your primary care physician, make sure he or she knows about this choice and is comfortable with it and willing to function this way.

The prevalence of older women in the workplace is greater now than it has ever been before, but evidence collected through a survey of women in the United Kingdom has recently suggested that women of menopausal age feel that their workplace performance has been hindered by the changes in their body during this time. That is no surprise. Menopausal symptoms can range from irregular menstruation starting in the perimenopausal stage to hot flashes, agitation, and even joint soreness or pain.

Many women report that they feel they do not perform as well, and that changes in their body due to menopause affects their productivity and the quality of the work that they produce. However, most express an unwillingness to discuss these problems with their employers, in large part due to the fact that – for the most part – their employers are younger men. While this study took place in the UK, it is applicable to the United States as well.

While all aging employees will likely see some decrease in their workplace abilities as they grow older, the predicament of women going through menopause is a sensitive subject—however, it is one that must be touched on in order to find a solution that works for these women and that does not make them feel as if they are “rocking the boat”, so to speak.

The study in question found four areas of concern that needed to be addressed. The first was a greater awareness of menopause and menopausal symptoms among employers. Along with that was a need for a more flexible schedule and a more comfortable workplace. However, one of the more important areas that this study advised should be broadened was the amount of support that menopausal women in the workforce should be able to receive as they go through this transition.

While not every workplace will have these resources available for women, it is a good reminder of how important it is for any woman to have a good source of support on hand as she progresses through this stage of her life.

Whether her support is a sister, a close group of friends, or even anonymous strangers through an Internet forum – one of the greater benefits of living in the virtual age – these resources can not only help a woman approaching menopause know what to expect from the changes in her body, but the experience of others can be a great resource to help women uncover ways in which they can broach the subject of menopause with employers and adapt to the changes in her body. By determining what to expect as her body changes a woman will know what to ask for and the concessions that may need to be made in order to keep her active, healthy, and – most importantly – happy in the workplace.

Endometriosis is an incredibly common condition among women, affecting upwards of seventeen percent of the population, but there is little awareness of this condition outside of those who suffer from it. Unlike other debilitating conditions that are cause for concern, as well as sympathy, endometriosis often goes unrecognized among the general population—however, it can have a significant impact on not only a woman’s physical health and wellbeing but her psychological health and her ability to maintain a social life and presence, according to research that has been done over the past few years to determine the impact of this disorder among sufferers.

Endometriosis is characterized by a number of symptoms, from extremely heavy menstrual bleeding to pain both during menstruation and at other times of the month. This is caused by an overgrowth of the uterine lining, which moves beyond the uterus and into other parts of the body, including the abdominal cavity. There is no cure for this disorder, and the primary methods of management include medications and, in certain cases, surgical intervention.

Women who suffer from endometriosis must work closely with their doctor to manage their symptoms, but there is still little that can be done to eliminate the symptoms that she faces entirely. This makes the disorder much more debilitating, especially during menstruation, and may lead to increased anxiety and stress as a result of either dealing with the symptoms, or even simply the anticipation of symptoms.

In this same study, which identified several areas in which women with endometriosis might be affected, it was also pointed out that there must be more research done on the significant impact of this disorder on the partners and children of women who suffer from it. Not surprisingly, it is incredibly stressful for those close to the woman with the disorder to deal with the pain that she must endure and the extra measures that they must take so that their own lives are affected as little as possible by it.

There is a great need of support for women who suffer from endometriosis—that is something that cannot be disputed. However, there is also a great need for the families of women affected by endometriosis to receive support as well. This can be especially difficult for male partners and younger children who do not understand the very real physiological effects of the illness.

The best method of coping is, as always, to raise awareness of the issue and for those affected by it to become educated as much as possible on the disorder. While it can be debilitating, there is no reason that women who suffer from endometriosis, as well as their families, cannot live happy and fulfilled lives. It is not up to the woman alone to cope, nor should it be. By working together with their families, women can ensure a more positive outcome and a higher quality of life.

It’s no secret by now that high heels are harmful to your health. You are probably aware that wearing high heels can increase your risk of falling or developing foot, leg, or back problems due to the pressure exerted on various parts of the foot and the misalignment of your ankles, hips, and spine. You probably already know that you should limit high heels to no more than two inches and avoid tight, pointy-toed shoes.

But did you know that your beloved flip-flops are just as bad?

Flip-flops literally expose your feet to a whole host of potential problems. From relatively benign issues like cold feet or stubbed toes to more serious injuries like cuts or broken bones, there are many problems which are completely avoidable by wearing protective and supportive shoes.

As if the potential for injury weren’t enough, researchers now suspect that flip-flops may prevent you from being as fit as you could be. When you wear flip-flops, you are forced to bunch your toes up to hold them on your feet. This prevents your arch from flexing naturally, which alters the way you walk. Think of this as a ripple effect, where you grip your shoes with your toes, which prevents you from flexing your arch, which prevents you from “pushing off” from each step strongly enough, which forces you to compensate with your hips, which puts more stress on your knees. The result is an unnatural gait that does not fully engage all the muscles in your legs and backside that walking should engage.

So think twice before wearing those flip-flops out to run errands or to the office (if you are lucky enough to work in that kind of office!). Flip-flops are great for occasional wear – to the pool or the beach – but not for hours on end, day after day. Your day-to-day shoes should be supportive and ergonomically correct. If you want to wear an open shoe like a sandal, at least make sure it has a strap that wraps around your ankle so that you aren’t tensing those toes up to hold the shoe on.

You should be aware that, with their lack of arch support, ballet flats do not fare much better under scrutiny than flip-flops. Incidentally, research shows no additional benefit from wearing “toning” sneakers; regular walking or running shoes will do just fine for exercise, and any comfortable, well-fitting shoes with good arch support are fine for daily wear.

Concern about the increased prevalence in teen pregnancies has raised a lot of questions societally as well as within the medical community. It is no secret that an event such as childbirth can play a large role in a woman’s health, and the potential changes that may take place are increased in a teenager, whose body is still growing and changing throughout adolescence. From very real concerns such as the potential for premature delivery to the psychological effects of becoming a mother at a very young age or giving a child up for adoption, there is much fodder for examination and research.

One study has even suggested that there is a potential association between adolescent pregnancy and obesity later in life. However, it is important to note that this association is still vague at best, and researchers have yet to uncover a cause for this heightened obesity risk. While it is possible that the associations between adolescent pregnancy and obesity is caused by the physiological changes that take place in the female body (and in particular the adolescent female body) during pregnancy, there are also many factors –primarily psychological and sociological—to take into consideration in order to determine the underlying cause of this association. I believe that these young women, obese or not obese, gain so much weight when they are pregnant that obesity is the result of the pregnancy and they cannot lose the weight postpartum, given the additional responsibilities of raising a child.

Demographically speaking, adolescent mothers are more likely to be from a racial minority, to have lived in poverty, or to have attained a lower educational level than many of their peers. Four out of five black women are either overweight or obese. It is highly likely that at least part of the association between adolescent pregnancy and weight gain is due to this “crossover”, as women of these demographics are also those most likely to be classed as overweight or obese. This is part of the difficulty in determining whether or not there are other physiological factors to take into account.

My take on the conclusions of this study and the entire situation of pregnant adolescents and future obesity is that these young women are looking for acceptance and have very low self-esteem. Their feelings are exploited by their male counterparts, who have a biological imperative to be intimate and not be rebuffed. Consequently, sexual intercourse is a form of being “accepted” and “loved”, only to find out later that the girl is pregnant, has gained excessive weight during the pregnancy and is now alone being responsible for a new life. Her old habits (no exercise and cheap fast food) with a low or nonexistent income lead to her obesity and that of her child. Then, it becomes a vicious cycle.

Regardless of the reasons for the prevalence of overweight and obese women among those who were pregnant as teenagers, studies like these highlight the importance of increased contraceptive aid and sexual education among female adolescents. At present, it seems that the primary association between these two groups of women, i.e., those who become pregnant as teenagers and those who are classed as overweight or obese in adulthood, is a lack of education or awareness about their bodies.

Mammograms are universally accepted as the most effective way of screening for breast cancer; however, is this really true? Many women may be surprised to learn that there is more than one method for detecting potentially life-threatening masses in the breasts, and these varying procedures are being used in an increasing number of women in the population. This is not to say that mammograms are not important or valuable as a detection tool in screening for breast cancers – however, in many cases it may not be effective when used alone, and as new screening technologies are developed and become more widespread an increasing number of women will need to work with their doctors to develop a more personalized approach to breast screenings.

According to a new report in the June issue of the American Journal of Medicine, for many years, mammography has been the sole imaging test recommended for breast cancer screening, and remains the only test proven to reduce breast cancer-related mortality. However, the widespread application of mammography in population-based screening remains controversial, owing to decreased sensitivity in women with dense breast tissue, radiation concerns, and a high rate of false-positive studies, leading to excessive breast biopsies. Those who image the breasts are adapting to these challenges with the development of new technologies. Low-dose mammography can reduce radiation risk to the breast. Contrast-enhanced mammography can evaluate blood flow in the breast, similar to MRI. Tomosynthesis produces multiple mammographic slices through the breast, similar to computerized tomography (CT scan), and has significant potential to lower recall rates and increase specificity.

The article goes on to say that both whole-breast ultrasound and MRI have been shown to detect additional cancers in certain high-risk populations and will likely be increasingly used in screening women with dense breasts. MRI studies are very expensive and have a high false positive rate, i.e., they have difficulty in identifying a negative on the image as a true negative (without disease) in the patient. However, a decrease in mortality has not been proven using these modalities. Molecular imaging in the form of BSGI and PEM of the breast is widely available. Positron emission mammography (PEM) and breast-specific gamma imaging (BSGI) use molecular imaging to increase specificity in cancer detection by demonstrating increased metabolic activity. However, due to relatively large whole-body radiation doses (equivalent to 20-30 mammograms), they are not currently suitable for annual screening.

The reason that the same method will not work with every woman is because every woman’s body is different. Variations in the structure of a woman’s breast, the density of her breast tissue, or even the existence of implants may affect the ability of the standard mammogram to fully detect any underlying lumps or irregularities in her breast tissue. Simply put, every woman’s breasts are different, and so too must the screening for every woman be different.

While these advances are encouraging, it is improbable that any of the new technologies will replace mammography for population-based screening programs, because all have significant limitations. Furthermore, given the heterogeneity of the human population, a “perfect” imaging technology for breast cancer screening will likely never be found. However, women who feel as if they have different needs should consult with their doctor and ask whether or not there may be special considerations they should make as a part of screening for cancers. However, ultimately the main thing that older women should do is to continue receiving their mammograms regularly as well as younger women (less than 35 years of age) conducting breast self-examinations on a regular basis within the comfort of their own home. In coming years it is likely that the plan of action for women will begin to change depending on individual women’s needs, but the existence of different technologies is still no substitute for the screening methods that are commonly accepted and readily available.

Depression is one of the most serious and prevalent disorders affecting women in the present day. It is also one of the most underreported disorders affecting women, and the number of those affected by it is increasing every year. Depression affects women of all age ranges and social statuses, and it affects those in poor health as well as those who are seemingly in perfect condition. With depression being so common, and affecting so many, it would seem that Ob-Gyn’s regularly diagnosis this problem in women. However, studies are suggesting that doctors miss a diagnosis of depression in as much as sixty percent of their patients.

Whether the women had a preexisting diagnosis of depression, reported suffering from psychological distress, or simply felt as if they might be depressed, their depression consistently went undiagnosed throughout visits with their Ob-Gyn. The most common signs recognized by doctors included physical manifestations of the disorder, such as weight gains and losses as well as reported insomnia.

Those that did receive a diagnosis were primarily women who were under twelve months postpartum, those under thirty-five years of age, and women who were seeing their Ob-Gyn either to discuss their depression symptoms or as part of a regular checkup. The most common visits in which the depression went unnoticed were visits in which the woman had scheduled an appointment to discuss an existing complaint.

This raises the all-important question—why do so many doctors miss depression diagnoses? There are likely a number of factors, ranging from the feeling of suffers that they are not in need of help to a reluctance to discuss any issues that are not “medical” with a medical practitioner. However, it is important for women to realize that depression is a medical issue, and it is one that can severely impact them throughout their lives—and it can even impact their health directly. Recognize that your mental state is just as important to report as your physical state and, most importantly, persistent feelings of sadness, loneliness, and lack of interest in one’s life are not feelings that must simply be “dealt with”. Your doctor can help.

Do you experience difficulty sleeping? If so, then you are not alone. More than a third of individuals report that they face some difficulty sleeping that leaves them tired throughout the day, whether that is insomnia, discomfort during sleep, or patterns of sleeping and waking in the middle of the night. An individual might have difficulty sleeping for any number of reasons, whether it is simply the fact that they are too busy to get the rest that they need or whether it is the result of some more severe issue related to emotional distress or anxiety. However, a new study suggests that sleep difficulties might be heightened in postmenopausal women. A person should receive between 71/2 and 8 hours of uninterrupted sleep a day.

In this study, both premenopausal women and postmenopausal women were asked to keep a diary tracking their typical sleep patterns across a two-week period. The results showed that postmenopausal women did show a lessened ability to get the recommended amount of sleep throughout the night. When compared to these women’s workday and leisure day schedules, it also showed that postmenopausal women were more likely to lose sleep related to the stresses of their workday. Consequently, postmenopausal women had less than 7 hours of sleep compared to their premenopausal counterparts who slept about seven and one-half hours.

It can be easy to brush off studies like these, or to think that you’ll simply make up the sleep later if you are one of those that regularly experiences sleep problems. However, there is more than enough evidence available to suggest that losing sleep could lead toward much bigger problems down the line. Despite the potential risks of going without sleep, insomnia and related issues are still one of the most underreported medical problems that many people, and especially women, face. Be sure that if you are experiencing sleep difficulties, you speak to your doctor about them—especially if these sleep difficulties are concurrent with any other life changes, whether they are medical or emotional.

Do you experience difficulty sleeping? If so, then you are not alone. More than a third of individuals report that they face some difficulty sleeping that leaves them tired throughout the day, whether that is insomnia, discomfort during sleep, or patterns of sleeping and waking in the middle of the night. An individual might have difficulty sleeping for any number of reasons, whether it is simply the fact that they are too busy to get the rest that they need or whether it is the result of some more severe issue related to emotional distress or anxiety. However, a new study suggests that sleep difficulties might be heightened in postmenopausal women. A person should receive between 71/2 and 8 hours of uninterrupted sleep a day.

In this study, both premenopausal women and postmenopausal women were asked to keep a diary tracking their typical sleep patterns across a two-week period. The results showed that postmenopausal women did show a lessened ability to get the recommended amount of sleep throughout the night. When compared to these women’s workday and leisure day schedules, it also showed that postmenopausal women were more likely to lose sleep related to the stresses of their workday. Consequently, postmenopausal women had less than 7 hours of sleep compared to their premenopausal counterparts who slept about seven and one half hours.

It can be easy to brush off studies like these, or to think that you’ll simply make up the sleep later if you are one of those that regularly experiences sleep problems. However, there is more than enough evidence available to suggest that losing sleep could lead toward much bigger problems down the line. Despite the potential risks of going without sleep, insomnia and related issues are still one of the most underreported medical problems that many people, and especially women, face. Be sure that if you are experiencing sleep difficulties, you speak to your doctor about them—especially if these sleep difficulties are concurrent with any other life changes, whether they are medical or emotional.